100%(33)33 out of 33 people found this document helpful
This preview shows page 27 - 31 out of 32 pages.
Newborn transition & initial care occur in labor & delivery room. > APGAR Scores should be obtained at 1 Minute and 5 Minutes after Birth.APGAR Scoreis a rapid assessment of 5 physiological signs that indicate the physiological status of the newborn including Activity (Muscle Tone) Muscle Tone on degree of flexion & movement of extremitiesPulse HR based on auscultation GrimaceReflex Irritability on response to tactile stimulation Appearance Color on observation Respirations RR based on observed movement of the chest
❖SEVERE Distress = 0-3❖MODERATE Difficulty with transition to extrauterine life = 4-6 ❖STABLE Status = 7-10 > Apgar Score is not used to determine need of resuscitation but it’s a rapid, objective, convenient shorthand for reporting the status of the newborn and the response of resuscitation after birth 31.Management of discomforts labor pg. 218Gate Control Theory: Labor pain is Acute & is transmitted from the periphery of thebody along nerve pathways to the brain. Uterine contractions from < in O2 supply to the uterus ^ pressure & stretching of pelvic structures Cervical Dilation/Stretching -> stimulation of the nerve ganglia 1st Stage of Labor - Pain is caused by●Uterine muscle hypoxia●Accumulation of lactic acid in the muscles ●Lower uterine and cervical stretching ●Traction on pelvic organs ●Pressure on the bony pelvis 2nd Stage of Labor - Pain is due to ●Pelvic muscle distension ●Pressure on the perineum, cervix, urethra and rectum> Back pain is thought to be caused by pressure of the fetal occiput on the maternal spine & pelvis > Pain is influenced by both physical& psychosocial factors 32. Pharmacologic & Nonpharmacologic pain relief pg. 219Non-pharmacological Management of Labor discomfort includes:●Preparation by the woman for childbirth ○Childbirth preparation classes○Relaxation & Breathing Techniques:Deep breath at beginning of contraction -> breath slowly through contraction ●Cutaneous Stimulation○Effleurage: lightly stroking the abd in rhythm with breathing during
contractions ○Back massage “Counter Pressure”to sacral area of mother ●Thermal Stimulation ○Application of Warm/Cold: < catecholamine production which interferes with uterine contractility & Cold may < sensation of pain ●Mental Stimulation○Focal points, Imagery, Music- focusing mother’s attention away from the pain ●Presence of support person○Provide emotional support, comfort○Doulas Pharmacological Management of Labor Discomfort > Requires nurse to assess the woman’s preference for pain management throughout labor A Pain Assessment needs to be completed ★2 Med Categories ○Analgesics: labor should be established ■Meperidine (Demerol) : opioid ■Butorphanol (Stadol): opioid agonist-antagonist ■Sublimaze (Fentanyl): short acting opioid antagonist ○Anesthesia: ■Local:analgesic injected into perineum at episiotomy site ■Regional:●Pudendal Block ●Epidural BlockCOMPLICATIONS W/ EPIDURAL: DECREASE BP & HYPOTENSION●Spinal Block ○General Anesthesia: used in emergency c-section